Certified Inpatient Coding (CIC) Practice Exam

Which indicator signifies a pass-through drug under the Outpatient Prospective Payment System?

1. A

2. E

3. F

4. G

The correct answer is: G

The indicator that signifies a pass-through drug under the Outpatient Prospective Payment System (OPPS) is indeed "G." Pass-through drugs are specific types of drugs that are eligible for separate payment under the OPPS system. They are generally high-cost items that do not fit within the packaged payment rates established for other outpatient services. The "G" indicator informs providers and payers that the drug should be billed separately from the other services rendered during an outpatient visit. This separate payment allows for a more accurate reimbursement reflecting the cost of those specific drugs. It is crucial for coding professionals to recognize this indicator to ensure proper billing and compliance with Medicare reimbursement guidelines. Understanding these indicators is essential for accurately coding outpatient services and for the financial health of the healthcare facility. Other indicators correspond to different categories of items or services within the OPPS, which may not indicate a pass-through situation, thus reinforcing the significance of the "G" indicator in this context.